Provider Demographics
NPI:1932491990
Name:YOUNG, SHANE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 TOPANGA CANYON BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-4000
Mailing Address - Country:US
Mailing Address - Phone:818-963-2291
Mailing Address - Fax:818-678-9571
Practice Address - Street 1:9800 TOPANGA CANYON BLVD STE E
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-4000
Practice Address - Country:US
Practice Address - Phone:818-963-2291
Practice Address - Fax:818-678-9571
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60219205111N00000X
CADC 32271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor